作　　者： (张学洪）; (周裔忠）; (周晓军）; (陈典立）; (盛国太）; (李华泰）;

机构地区： 江西省人民医院心内1科,南昌330006

出　　处： 《江西医药》 2017年第8期709-712,共4页

摘　　要： 目的 探讨术中测定左房平均压(Left atrial mean pressure,mLAP)及左室舒末压(Left ventricular end diastolic pressure,LVEDP)对行经皮球囊二尖瓣成形术(PBMV)时扩张终点的判断价值。方法 我院自2015年1月至2016年12月40例风湿性二尖瓣中重度狭窄且行PBMV的患者,随机分为对照组及实验组。对照组16例,采用传统的方法判断PBMV的扩张终点;实验组24例,采用测定m LAP及LVEDP判断扩张终点。所有患者于PBMV术后第1月、第3月、第6月复查超声心动图,记录左房内径、二尖瓣口面积、每搏输出量、6min步行距离等指标。结果 两组患者的PBMV成功率100%,无严重并发症及死亡病例,无需急诊外科干预情况,患者术后活动耐量提高,胸闷症状明显减轻,两组右房平均压力术前术后无明显改变,实验组的m LAP扩张前(28.2±2.1)mm Hg,扩张后(17.6±2.3)mm Hg(P<0.05),LVEDP扩张前(1±0.6)mm Hg,扩张后(5.1±0.4)5mm Hg(P<0.05)。术后随访结果 ,左房内径:对照组术前(50.6±3.6)mm,术后第1个月(47.6±2.63)mm,术后第3个月(44.2±2.52)mm,术后第6个月(42.6±2.48)mm;实验组术前(50.7±3.5)mm,术后第1个月(47.2±2.33)mm,术后第3个月(43.2±2.48)mm,术后第6个月(38.6±2.26)mm;二尖瓣瓣口面积:对照组术前(1.08±0.32)cm^2,术后第1个月(1.68±0.31)cm^2,术后第3个月(1.69±0.28)cm^2,术后第6个月(1.71±0.41)cm^2;实验组术前(1.02±0.30)cm^2,术后第1个月(1.85±0.29)cm^2,术后第3个月(1.87±0.21)cm^2,术后第6个月(1.88±0.43)cm^2。每搏输出量:对照组术前(52.4±6.2)ml,术后第1个月(57.3±5.8)ml,术后第3个月(58.4±6.2)ml,术后第6个月(58.2±5.4)ml;实验组术前(51.8±5.4)ml,术后第1个月(57.6±5.1)ml,术后第3个月(59.2±5.2)ml,术后第6个月(60.6±4.8)ml;平均6min步行距离对照组术前(346±14)米,术后第1个月(376±12)米,术后第3个月(375±11)米,术后第6个月(377±13)米;实验组术前(345±12)mm,术后第1个月(388±11)米,术后第3个月(387±13)米,术后第6个月(3 Objective To assess the role of the left atrial mean pressure（m LAP） and left ventricular end diastolic pressure（LVEDP） in the percutaneous balloon Mitral valv uloplasty（ PBMV）,40 cases with rheumatic mitral stenosis were divided into two groups（control group with 16 patients and experience group with 24 patients） randomly. Methods PBMV expansion end in the control group were operated by traditional method,PBMV expansion end in the experience group were operated by pressure monitoring（m LAP and LVEDP）. all patients were followed up for six months after PBMV,left atrial diameter（LAD）,mitral valve area（MVA）,stroke volume（SV） were detected by cardiac echocardiography,6 minutes walk test（6MWT） were performed. Results The success rate of PBMV was 100 percent. There were no difference in the right atrial pressure between corntrol group and experience group（P〉0.05）,Compared with preoperative,left ventricular end diastolic pressure increased by about 5mm Hg in the experience group. Compared with control group,LAD,MVA,SV and 6MWT were all improved. For the control group,LAD were（50.6 ±3.6）mm,（47.6±2.63）mm,（44.2±2.52）mm,（41.6±2.48）mm preoperation and 1st month,third month and sixth month after PBMV operation respectively. MVA were（1.08±0.32）cm^2,（1.68±0.31）cm^2,（1.69±0.28）cm^2,（1.71±0.41）cm^2） preoperation and 1st month,third month and sixth month after PBMV operation respectively,SV were（52.4±6.2）ml,（57.3±5.8）ml,（58.4±6.2）ml,（58.2±5.4）ml preoperation and 1st month,third month and sixth month after PBMV operation respectively,6 MWT were（346±14）m,（376±12）m,（375±11）m,（377±13）m preoperation and 1st month,third month and sixth month after PBMV operation respectively. For the control group,LAD were（50.7±3.5）mm,（47.2±2.33）mm,（43.2±2.48）mm,（39.6±2.26）mm preoperation and 1st month,third month and sixth month after PBMV operation respectively,MVA were（1.02±0.30）cm^2,（1.85±0.29）cm^

关 键 词： 风湿性 二尖瓣狭窄 经皮球囊二尖瓣成形术 左室舒张末压 左房平均压